News Scan for Jul 07, 2016

MERS developments
H3N2v susceptibility in kids
Viral vs bacterial infection test
Hepatitis death rise

MERS infects another in Saudi Arabia; WHO hints at 2 more clusters

Saudi Arabia's Ministry of Health (MOH) reported a new MERS-CoV infection, involving an 80-year-old woman from Jeddah who is a household contact of an earlier confirmed patient, and the World Health Organization (WHO) yesterday filled in more details about 13 recently reported cases from the country, 5 linked to a Riyadh hospital outbreak and at least 3 that appear to be linked to small clusters in Jeddah and Najran.

The woman who is Saudi Arabia's latest MERS-CoV (Middle East respiratory syndrome coronavirus) patient is in critical condition. Her illness lifts the country's MERS total to 1,424 cases, 601 of them fatal. Fifteen people are still being treated for their infections.

Meanwhile, the WHO's report covers cases reported by Saudi Arabia between Jun 21 and Jun 30. The five patients linked to the Riyadh hospital outbreak were asymptomatic and identified through contact tracing. They include three healthcare workers, a hospitalized patient, and a man who was exposed to the hospital patient.

The WHO's report also notes one of the three Jeddah patients is a 57-year-old woman who had been exposed to an earlier confirmed case-patient, a 66-year-old man whose illness source is still under investigation.

Hinting at another possible hospital cluster, this time in Najran, the WHO said one of the patients in its latest update is a 28-year-old male healthcare worker who had been exposed to an earlier confirmed case, a 44-year-old man whose source of the virus was unclear and is in critical condition and on a ventilator.

Of the other patients, four are from cities in different parts of the country: Al Aqiq, Dammam, Al Aflaj, and Al Hofuf. Sources of infection aren't known for three of the cases, but the case from Al Aflaj involves a 75-year-old man who had frequent contact with camels and often drinks raw camel milk.

The WHO said it has now received reports of 1,782 MERS-CoV cases, at least 634 of them fatal.
Jul 7 Saudi MOH statement
Jul 6 WHO update


H3N2v antibody study reveals susceptibility in children

Influenza A H3N2 strains that circulated between 1995 and 2005 are highly related to variant H3N2 (H3N2v), which might explain why young children were so susceptible, according to study of antibody response to a candidate H3N2v vaccine for humans. A research team based at Vanderbilt University published their findings today in JCI Insight.

The H3N2v strain, which contains the matrix gene from the 2009 H1N1 virus, sickened at least 345 people from 2011 to 2013, many of them children who had been exposed to swine at fairs and other exhibits.

From blood samples of healthy adults who took part in an earlier H3N2v trial, researchers isolated 17 monoclonal antibodies that neutralized the virus. Six of them strongly neutralized H3N2v but didn't disarm currently circulating H3N2 seasonal strains. However, the H3N2v antibodies neutralized H3N2 strains that circulated roughly a decade earlier, a time of several H3 spillovers from humans to pigs.

The group concluded that the findings likely explain why young children are susceptible to H3N2v, given that they haven't been exposed to human seasonal flu strains from the 1990s. They also said an H3N2v vaccine should target children.
Jul 7 JCI Insight study


Blood test shown to distinguish between viral, bacterial infections

A team of researchers from Stanford University School of Medicine and Cincinnati Children's Hospital Medical Center has developed a blood test that could one day enable doctors to quickly determine whether an infection has been caused by a bacterium or a virus. Their research was published yesterday in Science Translational Medicine.

The test, according to a Stanford University news release, is based on a set of seven genes—derived from publicly available patient gene expression data—whose activity changes in response to an infection. When the infection is bacterial, four of the genes become more active; when the infection is viral, three of the genes become more active. For the study, researchers tested the seven-gene test on blood samples from 96 critically ill children and found that the overall sensitivity and specificity for bacterial infection were 94.3% and 52.2%, respectively.

The researchers say the new test is an improvement over previous gene-expression tests because so few genes are involved. Those earlier tests, they write in the study, contain too many genes to translate into a useful clinical tool. But the seven-gene test is still likely years away from clinical use, as it still needs to be tested in clinical settings.

Ultimately, the researchers say, they hope to combine the seven-gene test with an 11-gene test they created last year. That test can determine whether the patient has an infection at all. The hope is that both tests would be run at the same time, and that doctors could have the results back within an hour.

The ability to quickly determine the nature of an infection means doctors could act faster with patients who have potentially deadly conditions like sepsis and need antibiotics. At the same time, it could help antibiotic stewardship efforts by reducing inappropriate use of the drugs.
Jul 6 Sci Transl Med study
Jul 6 Stanford University news release


Report: Rising hepatitis deaths eclipse TB, malaria, HIV

The largest comprehensive analysis so far on the burden of hepatitis revealed some startling findings: that deaths increased 63% over the 23-year study period and that the annual death toll now exceeds totals for tuberculosis (TB), malaria, and HIV/AIDS. Researchers from Imperial College London and the University of Washington published their findings yesterday in The Lancet.

Using data from the Global Burden of Disease study, the team looked at cases from 1990 to 2013 from 183 countries.

With the death toll now at 1.45 million, most fatalities were from hepatitis B and C, which can cause liver damage and liver cancer. Most occurred in East Asia, and, in an unusual pattern for an infectious disease, fatalities were evenly divided between low- and high-income countries.

Graham Cooke, MD, PhD, who led the team and is a clinical scientist at Imperial College London, said in a statement from the school that the B and C strains have high fatality rates, because they cause long-term infections with very few immediate symptoms. Despite effective treatments and vaccines, there is very little money invested in getting them to patients, compared with those for TB, malaria, and HIV/AIDS, he said.

"We now have a viral hepatitis global action plan approved in May by the World Health Assembly, and we now need to implement it."

The researchers also calculated years of life lost for hepatitis: more than 41 million for 2013. The years living with hepatitis-related disability total was 870,000, according to the report.

In a related Lancet commentary, two experts from the World Health Organization HIV/AIDS and global hepatitis program wrote that the new findings build a strong case for a greater national and international response, combining preventive steps such as vaccines and infection control as well as scaling up testing and treatment. They noted that high- and middle-income countries that don't receive development assistance will likely need to pull resources from their national health budgets to battle the hepatitis threat.
Jul 6 Lancet abstract
Jul 6 Imperial College London press release
Jul 6 Lancet commentary

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